From the WebMD Archives

Aug. 29, 2020 -- Chadwick Boseman, the star of the 2018 Marvel Studios megahit Black Panther, died of colon cancer Friday. He was 43.

Boseman, who was diagnosed 4 years ago, had kept his condition a secret. He filmed his recent movies ''during and between countless surgeries and chemotherapy," according to a statement issued on his Twitter account.

When the actor was diagnosed in 2016, the cancer was at stage III -- meaning it had already grown through the colon wall -- but then progressed to the more lethal stage IV, meaning it had spread beyond his colon.

Messages of condolences and the hashtag #Wakandaforever, referring to the fictional African nation in the Black Panther film, flooded social media Friday evening. Oprah tweeted: "What a gentle gifted SOUL. Showing us all that Greatness in between surgeries and chemo. The courage, the strength, the Power it takes to do that. This is what Dignity looks like. "

Marvel Studios tweeted: "Your legacy will live on forever."

Boseman was also known for his role as Jackie Robinson in the movie 42. Coincidentally, Friday was Major League Baseball's Jackie Robinson Day, where every player on every team wears Robinson's number 42 on their jerseys.

Boseman's other starring roles include portraying James Brown in Get on Up and U.S. Supreme Court Justice Thurgood Marshall in Marshall. But his role as King T'Challa in Black Panther, the super hero protagonist, made him an icon and an inspiration.

About Colon Cancer

Boseman's death reflects a troubling recent trend, says Mark Hanna, MD, a colorectal surgeon at City of Hope, a comprehensive cancer center near Los Angeles. "We have noticed an increasing incidence of colorectal cancer in young adults," says Hanna, who did not treat Boseman. "I've seen patients as young as their early 20s."

About 104,000 cases of colon cancer will be diagnosed this year, according to American Cancer Society estimates, and another 43,000 cases of rectal cancer will be diagnosed. About 12% of those, or 18,000 cases, will be in people under age 50. As the rates have declined in older adults due to screening, rates in young adults have steadily risen.

Younger patients are often diagnosed at a later stage than older adults, Hanna says, because patients and even their doctors don't think about the possibility of colon cancer. Because it is considered a cancer affecting older adults, many younger people may brush off the symptoms or delay getting medical attention, Hanna says.

In a survey of 885 colorectal cancer patients conducted by Colorectal Cancer Alliance earlier this year, 75% said they visited two or more doctors before getting their diagnosis, and 11% went to 10 or more before finding out.

If found early, colon cancer is curable, Hanna says. About 50% of those with colon cancer will be diagnosed at stage I or II, which is considered localized disease, he says. "The majority have a very good prognosis." The 5-year survival rate is about 90% for both stage I and II.

But when it progresses to stage III, the cancer has begun to grow into surrounding tissues and the lymph nodes, Hanna says, and the survival rate for 5 years drops to 75%. About 25% of patients are diagnosed at stage III, he says.

If the diagnosis is made at stage IV, the 5-year survival rate drops to about 10% or 15%, he says.

"Unfortunately, African Americans are more likely to develop colorectal cancer at a younger age  and to be at a more advanced stage when diagnosed," says Elena Ivanina, DO, a gastroenterologist at Lenox HIll Hospital, New York, according to the National Cancer Institute and the Colon Cancer Coalition.   "Even when African Americans are diagnosed with early stage disease, they have significantly worse survival rates.''

Overall, ''colorectal cancer remains a condition that on one hand can be prevented with screening colonoscopy, but on the other a lethal progressive cancer if not caught early."

Experts have been trying to figure out why more young adults are getting colon cancer and why some do so poorly. "Traditionally we thought that patients who are older would have a worse outlook," Hanna says, partly because they tend to have other medical conditions too.

Some experts say that younger patients might have more ''genetically aggressive disease," Hanna says. "Our understanding of colorectal cancer is becoming more nuanced, and we know that not all forms are the same." For instance, he says, testing is done for specific genetic mutations that have been tied to colon cancer. "It's not just about finding the mutations, but finding the drug that targets [that form] best."

Paying Attention to Red Flags

"If you have any of what we call the red flag signs, do not ignore your symptoms no matter what your age is," Hanna says. Those are:

In 2018, the American Cancer Society changed its guidelines for screening, recommending those at average risk start at age 45, not 50. The screening can be stool-based testing, such as a fecal occult blood test, or visual, such as a colonoscopy.

Hanna says he orders a colonoscopy if the symptoms suggest colon cancer, regardless of a patient's age.

Family history of colorectal cancer is a risk factor, as are being obese or overweight, being sedentary, and eating lots of red meat.

WebMD Health News


Elena Ivanina, DO, gastroenterologist, Lenox Hill Hospital, New York.   

Mark Hanna, MD, colorectal surgeon and assistant clinical professor of surgery, City of Hope, Los Angeles. 

American Cancer Society: "Key Statistics for Colorectal Cancer."

Twitter statement: Chadwick Boseman.

American Cancer Society: "Colorectal Cancer Risk Factors."

American Cancer Society: '"Colorectal Cancer Rates Rise in Younger Adults."

American Society of Clinical Oncology annual meeting, May 29-31, 2020.

American Cancer Society "Survival Rates for Colorectal Cancer."

American Cancer Society: "Colorectal Cancer Facts & Figures: 2017-2019."

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